EP1653883A1

EP1653883A1 - Stent for implantation in a blood vessel, especially in the region of the aortic arch

Info

Publication number: EP1653883A1
Application number: EP04763937A
Authority: EP
Inventors: Ralf Kaufmann; Rainer Lesmeister; Hardy MÜLLER; Michael Braun; John Geis
Original assignee: Jotec GmbH
Current assignee: Jotec GmbH
Priority date: 2003-08-12
Filing date: 2004-08-10
Publication date: 2006-05-10
Anticipated expiration: 2024-08-10
Also published as: DE10337739A1; DE10337739B4; EP1653883B1; US8668729B2; WO2005013854A1; ES2532371T3; US20060195177A1

Abstract

A stent (10) for implantation in a blood vessel (15), especially in the region of the aortic arch (12), comprising rings (23, 28, 29) which are disposed successively in the longitudinal direction thereof and which are made of meander-shaped peripheral supports (24) and a prosthesis material (25) which is fixed to the rings (23, 28, 29) and which connects them, said material forming a hollow cylindrical body (22) with a jacket (26) which is substantially closed on the periphery thereof. At least one connecting support (31; 61, 62; 71, 72) is provided between the last ring (28) and the penultimate ring (29) on the proximal send (11) of the stent (10). Said connecting support connects the two rings (28,29) to each other.

Description

Stent for implantation in a blood vessel, especially in the area of the aortic arch

The present invention relates to a stent for implantation in a blood vessel, in particular in the area of the aortic arch, with rings of meandering circumferential supports arranged one behind the other in the longitudinal direction and a prosthesis material fastened to and connecting these rings, which has a hollow cylindrical body with a circumferentially essentially closed jacket forms.

Such a stent, but not for implantation in the aortic arch, is known from the prior art.

These vascular stents, also known as endovascular stents, are implanted in the arteries for the treatment of aneurysms. An aneurysm is understood to mean an expansion or drainage of an arterial blood vessel as a result of congenital or acquired wall changes. The bagging can cover the vessel wall as a whole or, in the case of a so-called false aneurysm, blood can pass from the lumen of the vessel between the vessel wall layers and shear them apart. Failure to treat an aneurysm in advanced stages can lead to rupture of the artery, causing the patient to bleed internally.

Although aneurysms often occur in the abdominal artery (abdominal aorta) or thoracic artery (thoracic aorta), an aneurysm can also occur in the area of the ascending or descending branch of the aorta (ascending aorta and descending aorta). The ascending branch of the aorta is directly connected to the heart. Starting from the aortic root (sinus aortae), the ascending branch runs upwards in a slightly curved shape from the heart and merges into the aortic arch (arcus aortae). In the area of the aortic arch, the head vessels branch off, e.g. the left and right carotid arteries. The aortic arch has a curve of approximately 180 ° with a very narrow radius and connects the ascending branch of the aorta with the descending branch.

A stent for implantation in the ascending branch of the aorta is known from DE 100 65 824 AI. The known stent has a hollow, hollow-cylindrical body which is open in the longitudinal direction for the passage of blood and has a wall which is formed by a mesh structure. The body of the known Stents are adapted to the anatomical shape of the aortic root and have a concave shape. At its proximal end facing the heart, narrow fixing elements are arranged distributed around the stent in the circumferential direction. At its distal end, which extends into the aortic arch, the body of the known stent is cut off obliquely, so to speak, so that the stent has a greater length extension on its peripheral region, which in the implanted state is remote from the head vessels, than at the opposite peripheral region. In this way it is avoided that the head vessels branching from the aortic arch are covered by the stent.

The known stent has proven to be suitable for use in the area of the ascending aorta, but because of the completely different anatomical relationships in the area of the descending aorta, such a stent cannot be used to treat aneurysms in the area of the descending aorta.

The problem with such thoracic aortic aneurysms, which may extend into the aortic arch, i.e. to the left subclavian artery (A. subclavia sinistra), is that there is insufficient proximal fixation and sealing surface for the stents. In other words, the known stent cannot be adequately fixed in the aortic arch opposite and proximal to the outlet of the subclavian sinus artery.

In such a case, surgical interventions are therefore required before the endoluminal implantation of a vascular endoprosthesis, that is, a corresponding stent. Before the stent is implanted, a vascular surgical connection between the proximal of the subclavian sinus artery and the aortic against the outgoing common carotid artery and the subclavian sinus artery, so that the subclavian artery is supplied through the common carotid artery. The exit of the clavicle artery from the aortic arch can then easily be covered by a vascular endoprosthesis and closed by this in order to ensure a sufficient fixation and sealing surface on the aortic inner wall.

Vascular surgery of this type is very time-consuming, the patient must also be connected to a heart-lung machine and the patient's body temperature must be cooled down considerably. For this reason, the mortality rate for such interventions is very high.

Another disadvantage is the fact that emergency care for a patient with a thoracic aortic aneurysm by inserting a stent in a minimally invasive way has hitherto been virtually impossible since a sufficiently secure fixation of the proximal end of the stent causes problems.

Against this background, the object of the present invention is to create a stent of the type mentioned at the beginning, which can be placed with its proximal end in the region of the aortic arch.

In the case of the stent mentioned at the outset, this object is achieved in that at least one connecting support is provided between the last and the penultimate ring at the proximal end of the stent, which connects these two rings to one another. The object underlying the invention is completely achieved in this way.

The inventors of the present application have recognized that stents with a jacket made of prosthesis material are suitable for implantation into the A. descencens if only a connecting support is provided between the last and the penultimate ring, which connects these two rings to one another. In the case of the stent suitable for implantation in the ascending artery according to DE 100 65 824, the distal end of the stent lying in the aortic arch is chamfered and, if necessary, open-meshed to ensure that the arteries in the head are supplied. Such a mesh stent is not suitable for the treatment of aneurysms in the area of the descending aorta, although a pure bevel at the proximal end of the stent lying in the aortic arch enables the outgoing arteries to be supplied, but not sufficient fixation. By contrast, the connecting support now makes it possible, for example, to cut out part of the lateral surface between the last and the penultimate ring or to provide the jacket with holes, so that the supply to the outgoing head arteries is ensured. On the other hand, both the last ring and the connection supports ensure that the proximal end of the new stent is securely fixed in the aortic arch.

In this case, it is preferred if between the last and the penultimate ring in the area of the connection support a covering region that is essentially free of prosthesis material is stretched, the connection support preferably being V-shaped and more preferably that essentially of The prosthesis-free jacket area widens in a wedge shape towards the proximal end of the stent.

The advantage here is that, on the one hand, the entire jacket area between the last and the penultimate ring is not formed without prosthesis material. This makes it possible to provide prosthesis material on the inner wall of the aortic arch, which is remote from the outlets of the head arteries, and thus a jacket region which is used not only for support but also as a sealing surface. The V-shaped design of the connection support makes it particularly easy to implement the sheath region that widens in a wedge shape toward the proximal end of the stent and is free of prosthesis material. The jacket is removed in the area of the wedge-shaped jacket area, the resulting edges of the prosthesis material being fastened to the V-shaped struts of the connecting support.

While the individual rings in the distal region of the new stent are connected to one another only via the jacket, that is to say the prosthesis material, the connection between the last and the penultimate ring is also made on the one hand via the jacket, but on the other hand also via the connecting support. The connecting support ensures that the last ring at the proximal end is securely connected to the remaining hollow cylindrical body of the stent, despite the partially removed jacket.

In general, it is preferred if the supports have a Z-shaped course with pointed arches alternatingly pointing to the proximal and distal ends of the stent, which are oblique to the Longitudinal support sections are connected to each other.

In this way, a stent structure is created which exerts sufficient radial pressure to anchor itself in the vascular regions located proximal and distal to the aneurysm, while the stent can withstand the pressure from the blood flowing through it.

It is preferred if the proximal pointed arches of the last ring are at a distance from the proximal pointed arches of the penultimate ring that is greater than the distance between the proximal pointed arches of the penultimate ring and the proximal pointed arches of the penultimate ring.

In other words, the last ring is at a greater distance from the penultimate ring than the other rings in the stent among one another.

This has the advantage that the stent can more easily adapt to the curvature in the aortic arch at its proximal end. On the one hand, this is already made possible by the jacket region, which is essentially free of prosthesis material, but due to the greater distance between the rings at the proximal end, the stiffness is determined more strongly by the remaining prosthesis material than in the other area of the stent, which enables better flexibility.

It is further preferred if the proximal pointed arches of the last ring are at a distance from the distal pointed arches of the penultimate ring which is greater than the distance between see the exit of the subclavian sinistra artery and the exit of the common carotid artery from the aortic arch.

This measure has the advantage that the proximal pointed arches of the last ring can lie proximally from the common carotid artery to the inner wall of the aortic arch, while the distal pointed arches of the penultimate ring lie against the inside of the aortic wall distal from the subclavian sinus artery , On the one hand, this ensures that the proximal end of the new stent is securely anchored in the aortic arch, while at the same time preventing excessive pressure being exerted on the inner wall of the aortic area in the area of the branches from the common carotid artery and subclavian artery. Furthermore, this construction makes it possible to choose the sheath region that is essentially free of prosthesis material so that the branches of the common carotid artery and subclavian artery are not covered by prosthesis material.

In general, it is preferred if a pointed arch of the penultimate ring facing the distal end of the stent is in contact with a pointed arch of a connecting support, the pointed arch of the penultimate ring facing the distal end of the stent preferably being formed at least partially by the pointed arch of the connecting support.

The advantage here is that the Z-shaped course of the penultimate ring is not changed by the connection support, rather the connection support fits into the usual structure of the ring. The distal pointed arch of the penultimate ring can be partially omitted, the resultant gap is filled by the pointed arch of the connection support.

It is further preferred if the connection support has two legs, each of which is in contact with a support section of the last ring at its proximal end.

The advantage here is that the Z-shaped course of the last ring does not have to be changed by the connection with the connection support.

It is further preferred if the connection support has two legs, each of which is in contact with a support section of the penultimate ring at its distal end.

As already mentioned, this measure has constructive advantages, the Z-shaped course of the last and penultimate ring is not disturbed.

Another advantage is that due to this structure, pressure on the last ring causes the V-shaped connection support to expand outwards, so that the prosthetic material attached there is pressed outwards against the inner wall of the aortic area, thus sealing the blood flow against it forms the aneurysm volume. The area of the support of the proximal last ring which is not covered by prosthesis material thus bends the proximal end of the prosthesis covered by prosthesis material along the toroidal aortic inner wall and at the same time spreads the wedge-shaped uncovered area with respect to the supra-aortic vascular outlets and presses on the legs of the connection support for sealing the blood flow against the aneurysm volume.

In the above embodiments of the stent according to the invention, the number of pointed arches of the last ring can be equal to that of the penultimate ring.

In another embodiment, it is preferred if the number of pointed arches of the last ring is less than the number of pointed arches of the penultimate ring.

The stent, or the distribution of the pointed arches in the last ring of the stent, can be designed, for example, in such a way that there is no free distal pointed arch in the sheath region which is essentially free of prosthesis material and which is spanned in the area of the connection support. As a result, in this embodiment, the stent cannot get caught in the vessel walls when it is withdrawn in the distal direction.

This embodiment can also be designed, for example, in such a way that no distal pointed arch is formed in the last ring at that point which corresponds to the pointed arch of the penultimate ring pointing towards the distal end of the stent, which is at least partially formed by the pointed arch of the connecting support. opposite.

In yet another embodiment it is preferred if at least two further connection supports are provided, each of which is in contact with a support section of the last ring with its proximal end and with a support section of the penultimate ring in each case with its distal end. In a further embodiment, it is further preferred if the two further connection supports intersect at one point.

The flank stability and flank tightness can advantageously be increased by the further connecting supports of these embodiments.

These embodiments also have the advantage that the stability of the stent is supported, in particular in the distal region, which also prevents problems with hooking of the pointed arches when the stent is withdrawn in the distal direction.

It is further preferred if the last ring and the connection support are integrally formed with one another.

This measure is structurally advantageous, it is only necessary to bend a conventional Z-shaped ring and then to extend one of the free ends in the direction of the distal region, to deflect it there and to return it to the last ring.

In general, it is preferred if the respective support section of the last or penultimate ring and a section of the connection support which is in contact therewith are connected to one another by a compression sleeve.

On the one hand, this measure is structurally advantageous, because the wire regions lying against one another are crimped to one another in this way. However, this measure is also Safety aspects of advantage, because in this way the free ends of both the penultimate and the last ring are covered by the crimp sleeves, so that injuries to the aortic inner wall are avoided.

It is further preferred if the pointed arches of the last ring facing the proximal end of the stent are bent outwards relative to the pointed arches facing the distal end of the stent.

This measure has the advantage that the proximal pointed arches adapt to the inner wall of the aortic arch, which can be regarded as a good approximation as the inner surface of a torus segment. At the same time, the outward-curved pointed arches create pressure on the aortic wall due to the elasticity of the wire material, which ensures the fixation and positioning as well as the sealing effect of the vascular endoprosthesis, i.e. the stent.

In general, it is preferred if the supports and the connecting support consist of a wire-shaped, elastic material.

This measure is known per se; it ensures that the stent can first be compressed for insertion into the lumen of the aorta, so that its outer diameter is reduced. After the stent is released, it expands and anchors itself in the corresponding blood vessel.

In general, it is preferred if a distal to a distal pointed arch of the connection support on the jacket Marker is attached, wherein a proximal marker is also preferably arranged distal to a support section of the last ring on the jacket, the markers preferably being X-ray markers.

This measure has the advantage that a positioning aid is created, by means of which the current position of the stent can be tracked during the implantation and to check the position of the sheath region which is essentially free of prosthesis material compared to the supra-aortic outlets after the implantation.

In general, it is preferred if the prosthesis material consists of textile material or of foil, wherein the prosthesis material is further preferably attached to the supports and the connecting support by sewing, gluing or melting.

These measures are known from the prior art; they enable the new stent to be manufactured quickly and inexpensively, but nevertheless safely.

Further advantages and features result from the following description and the attached drawing.

It goes without saying that the features mentioned above and those yet to be explained below can be used not only in the combination specified in each case, but also in other combinations or on their own without departing from the scope of the present invention. An embodiment of the invention is shown in the drawing ^* and is described in more detail below with reference to this. Show it:

1 shows a schematic representation of an embodiment of an endovascular stent implanted in the descending branch of the aorta;

FIG. 2 shows the support structure for the stent from FIG. 1, but without the surrounding jacket;

3 shows the proximal last and penultimate ring of the stent from FIG. 2, still without connection to one another;

4 shows the two rings from FIG. 3, but now connected to one another by pressing sleeves;

5 shows a further embodiment of the stent according to the invention without a surrounding jacket;

6 shows yet another embodiment of the stent according to the invention with additional connection supports, likewise without a surrounding jacket;

7a shows the proximal last and penultimate ring of the stent from FIG. 6, with the connecting supports to be attached, but still without the connection to one another;

7b shows the two rings from FIG. 7a, now interconnected by pressing sleeves; FIG. 8 in turn shows a further embodiment of the stent according to the invention with intersecting additional connection supports without a surrounding jacket;

FIG. 9a the proximal last and penultimate ring of the stent from FIG. 8, with the connecting supports to be attached and crossing, still without connection to one another; and

Fig. 9b, the two rings from Fig. 9a, now interconnected by compression sleeves.

In FIG. 1, a stent is shown at 10, which is anchored with its proximal end 11 in the aortic arch 12 and with its distal end 14 in the descending aorta 15.

Before the stent 10 is described in more detail, the aortic system, which is also shown schematically in FIG. 1, will first be explained.

The ascending branch 16 (ascending artery) of the aorta is connected to the left ventricle of the heart, also not shown, via the aortic root (sinus aortae), which is not shown in FIG. 1. The ascending aorta 16 is connected to the descending aorta 15 via the aortic arch 12. In the area of the aortic arch 12 there are arterial head vessels, namely the trunk trunk truncus brachiocephalicus 17, the common carotid artery 18 and the subclavian sinus artery 19.

An aneurysm is shown at 21 in the descending aorta 15, which is, so to speak, bridged by the stent 10. The Blood flow coming from the ascending aorta 16 passes through the aortic arch 12 into the proximal end 11 of the stent 10 and leaves it at the distal end 14. For this purpose, the stent 10 has a hollow cylindrical body 22, which is shown schematically in FIG indicated rings 23 is formed from meandering supports 24 which are connected to each other by prosthesis material 25. The prosthesis material 25 is a textile material or a film in a known manner and is fastened to the supports 24 by sewing, gluing or melting.

In this way, the passage through the stent is kept open, so that the hollow cylindrical body 22 is formed.

At its proximal end 11, the stent 10 has a wedge-shaped, free sheath region 27 that widens toward the proximal end 11 and is stretched between a proximal last ring 28, a proximal penultimate ring 29 and a connecting support 31 that also supports the last ring 28 connects the penultimate ring 29.

This mantle region 27, which is essentially free of prosthesis material 25, makes it possible for blood brought from the ascending aorta 16 to reach the common carotid artery 18 and the subclavian sinus artery 19. Outside the free sheath area 27, however, there is prosthesis material 25 between the last ring 28 and the penultimate ring 29, so that the stent 10 here clings closely to the aortic inner wall indicated at 30 with its proximal end. This prevents blood from passing between the stent 10 and the aortic inner wall 30 into the region of the aneurysm. mas 21 succeeded, possibly expanding it further and finally leading to rupture.

The structural design of the stent 10 from FIG. 1 is shown in more detail in the schematic side view of FIG. 2, the prosthesis material 25 being omitted in FIG. 2 for reasons of clarity.

First of all, it can be seen that the last ring 28, the penultimate ring 29 and further rings 23 are arranged one behind the other in the longitudinal direction 32, only one of which is shown. Each of these rings 23, 28, 29 has a plurality of proximal pointed arches 33 and distal pointed arches 34 which are connected to one another by support sections 35 which run obliquely to the longitudinal direction 32. In this way, the rings 23, 28 and 29 consisting of meandering circumferential supports 24 are formed. It should also be mentioned that both the supports 24 and the connecting support 31 consist of a wire-shaped, elastic material.

The proximal pointed arches 33 of the last ring 28 are at a distance from the proximal pointed arches 33 of the penultimate ring 29 which is greater than the distance 37 between the proximal pointed arches 33 of the penultimate ring 29 and the proximal pointed arches 33 of the penultimate ring 23 In this way, the stent 10 is more flexible and movable at its proximal end 11 than in the direction of its distal end 14.

Furthermore, the proximal pointed arches 33 of the last ring 28 face the distal pointed arches 34 of the penultimate ring 29 Distance 38, which is greater than the distance 39 indicated in FIG. 1 between the exit of the subclavian artery sinistra 19 and the exit of the common carotid artery 18 from the aortic arch 12. In this way, the proximal last ring 28 can be located proximally from the artery Carotis communis clamp against the aortic inner wall 30, while the penultimate ring 29 clamp distally to the subclavian sinus artery and there the prosthesis material 25 can press against the inner circumference of the aortic wall 30.

The V-shaped connecting support 31, which connects the last ring 28 and the penultimate ring 29 to one another, has a distal pointed arch 41 and two legs 42 adjoining the pointed arch 41, which extend in a V-shape to the distal end 11 of the stent 10 , The legs 42 have their proximal ends 43 in contact with support sections 35 of the last ring 28. With their distal ends 44, the legs 42 are in contact with corresponding support sections 35 of the penultimate ring 29. The connection between the support sections 35 and the respective ends 43 , 44 of the leg 42 takes place via pressing sleeves 45, which also close the meandering supports 24, for example of the ring 23, to their Z-shaped course.

In Fig. 3, the last ring 28 and the penultimate ring 29 are shown immediately after manufacture, that is, before the connection with each other.

It can be seen on the left in FIG. 3 that the last ring 28 and the connecting support 31 are formed in one piece with one another. Furthermore, it can be seen in FIG. 3 on the right that the penultimate ring 29 lacks, so to speak, a distal pointed arch 34, which is represented by a gap indicated at 48. This gap is now filled by the distal pointed arch 41 of the connection support 31.

The last ring 28 is formed starting at its free end 49 by multiple Z-shaped bending of the corresponding wire material, so that the proximal and distal arches 33 and 34 are formed. When the ring 28 is closed, the wire material is advanced distally and bent at the distal arch 41 and returned to the support section 35 where the wire is cut off to give the second free end 50 of the one-piece structure which is both the last ring 28 and also represents the connection support 31. The penultimate ring 29 accordingly has two free ends 51 and 52, which are located on both sides of the gap 48.

The last ring 28 and the penultimate ring 29 are now brought together as shown in FIG. 4, with a compression sleeve 45 being pushed onto the free ends 49 to 52, which on the one hand connects the legs 42 to the corresponding support sections 35 and on the other hand, the free ends 49 to 52 are covered, so that damage to the inner wall of the aortic is avoided.

The last ring 28 and the penultimate ring 29 together with the connection support 31 form a fixation structure which is provided at the proximal end 11 of the stent 10. With this fixation structure, the inner wall of the aorta opposite and proximal to the outlet of the subclavian artery can also be used as a fixation and sealing surface without this outlet being closed. If the new stent in it for that implanted area, it is no longer necessary to carry out a stressful service intervention beforehand.

It should also be mentioned that the proximal pointed arches 33 of the last ring 28 are widened or bent outwards relative to the distal pointed arches 34, which can be seen in FIG. 2 at the top. As a result, the pointed arches 33 adapt to the aortic inner wall 30 and at the same time generate pressure on the inner aortic wall 30 due to the elasticity of the wire material, which ensures the fixation and positioning as well as the sealing effect of the vascular endoprosthesis.

In FIG. 1 it can also be seen that the last ring 28 can be bent forward, as a result of which the legs 42 of the connecting support 31 spread outward and fit closely against the aortic inner wall 30. This is further supported by the pressure exerted by the inner wall of the aortic on the last ring 28, which also expands the legs 42 of the connecting support 31 to the outside under pressure. In this way, the prosthesis material fastened there is pressed outward against the aortic inner wall 30 and thus forms a seal of the blood flow against the volume of the aneurysm 21.

The area 27 remaining free from the prosthesis material 25 ensures the appropriate supply of the subclavian sinus artery 19 and the common carotid artery 18.

As a positioning aid during the implantation and for checking the position of the uncovered prosthesis area, that is to say the free jacket area 27 relative to the supraaortic outlets 19 and 18 after the implantation serve two X-ray markers 46 and 47, which can be seen in FIG. 1. The marker 46 is a distal marker, which is arranged distral to the distal pointed arch 41 of the connecting support 31. The marker 47, on the other hand, is a proximal marker that is attached distally to a support section of the last ring 28 on the jacket 26.

A further embodiment of the stent according to the invention is shown in a schematic side view in FIG. 5, the prosthesis material 25 also being omitted here, as in FIG. 2, for reasons of clarity. 5 to 9a, the same reference numerals as in Fig. 2 have been used to designate the same elements of the stents.

5 that in this embodiment too the last ring 28, the penultimate ring 29 and further rings 23 are arranged one behind the other in the longitudinal direction 32, only one of which is shown. It can also be seen that the last ring 28 has a proximal pointed arch 33 - and thus also a distal pointed arch 34 - less than the penultimate ring 29 and than the ring 23. In this embodiment, the distal one is therefore missing in comparison to FIG. 2 Ogive 39 (see Fig. 2).

FIG. 6 shows a further embodiment of the stent according to the invention, this embodiment having additional connection supports 61 and 62 in comparison to the embodiment from FIG. 2. The connecting supports 61 and 62 are each with their proximal end 63 with a support section 35 of the last ring 28 and with their distal end 64 each with a support section 35 of the penultimate ring 29 in Plant brought. It can be seen in FIG. 6 that the additional connection supports 61 and 62 thereby represent a type of flank reinforcement for the stent.

In Fig. 7a, the last ring 28 and the penultimate ring 29 are shown immediately after manufacture, that is, before they are connected to one another. 7a - as in FIG. 3 - it can be seen that the last ring 28 and the connecting support 31 are formed in one piece with one another. The additional connecting supports 61 and 62 are brought into contact with their proximal end 63 with a support section 35 of the last ring 28, which is indicated by the arrows 65, and the distal ends 64 each with a support section 35 of the penultimate ring 29, which is indicated by the Arrows 66 is indicated.

In FIG. 7b it can be seen that the two rings 28 and 29 are brought together, the ends each being connected to the corresponding support sections 35 via press sleeves 68, so that injuries to the aortic inner wall are avoided.

A further embodiment of the stent according to the invention is shown in FIG. 8, two additional connection supports 71 and 72 also being provided here as in FIG. 6, but which intersect at a point 77.

Similar to FIG. 7a, it can be seen in FIG. 9a that the intersecting connecting supports 71 and 72 are each brought into abutment via their proximal end 73 with a support section 35 of the last ring 28, which is indicated by the arrows 75, and with its distal end 74 with a support section 35 of the penultimate ring 29, which is indicated by the arrows 76.

9b shows that the two rings 28 and 29 are brought together, the ends of the connecting supports 71 and 72 being connected to the respective support sections 35 of the last ring 28 and the penultimate ring 29 by attaching compression sleeves 68 ,

Claims

claims

1. Stent for implantation in a blood vessel (15), in particular in the area of the aortic arch (12), with rings (23, 28, 29) arranged one behind the other in its longitudinal direction (32) and consisting of meandering supports (24) and one on the rings (23, 28, 29) attached and connecting these prosthesis material (25), which forms a hollow cylindrical body with a circumferentially substantially closed jacket (21), characterized in that between the last (28) and the penultimate (29) ring on the proximal At least one connection support (31) is provided at the end (14) of the stent (10) and connects these two rings (28, 29) to one another.

2. Stent according to claim 1, characterized in that between the last and the penultimate ring (28, 29) in the area of the connecting support (31) is a substantially free of prosthesis material (25) jacket area (27) is stretched.

3. Stent according to claim 1 or 2, characterized in that the connection support (31) is V-shaped.

4. Stent according to claim 2 or 3, characterized in that the man-substantially free of prosthesis material (25) telregion (27) widens in a wedge shape to the proximal end (11) of the stent (10).

Stent according to one of claims 1 to 4, characterized in that the supports (24) have a Z-shaped course with pointed arches (33, 34) pointing alternately to the proximal (11) and the distal (14) end of the stent (10) which are connected to one another by support sections (35) which run obliquely to the longitudinal direction (32).

Stent according to claim 5, characterized in that the proximal pointed arches (33) of the last ring (28) to the proximal pointed arches (33) of the penultimate ring (29) have a distance (36) which is greater than the distance (37) between the proximal pointed arches (33) of the penultimate ring (29) and the proximal pointed arches (33) of the penultimate ring (23).

Stent according to claim 5 or 6, characterized in that the proximal pointed arches (33) of the last ring (28) to the distal pointed arches (34) of the penultimate ring (29) have a distance (38) which is greater than the distance ( 38) between the branch of the subclavian sinus artery (19) and the branch of the common carotid artery (18) from the aortic arch (12).

Stent according to one of claims 5 to 7, characterized in that a pointed arch (41) of the penultimate ring (29) facing the distal end (14) of the stent (10) is in contact with a pointed arch of the connecting support (31).

9. Stent according to claim 8, characterized in that the pointed arch (41) of the penultimate ring (29) facing the distal end (14) of the stent (10) is at least partially formed by the pointed arch (1) of the connecting support (31).

10. Stent according to one of claims 5 to 9, characterized in that the connecting support (31) has two legs (42), each at its proximal end (43) with a support section (35) of the last ring (28) in contact are.

11. Stent according to one of claims 5 to 10, characterized in that the connecting support (31) has two legs (42), each at its distal end (44) with a support section (35) of the penultimate ring (29) in contact are.

12. Stent according to one of claims 1 to 11, characterized in that the number of pointed arches (33; 34) of the last ring (28) is less than the number of pointed arches (33, 34) of the penultimate ring (29).

13. Stent according to one of claims 5 to 11, characterized in that at least two further connection supports (61, 62; 71, 72) are provided, each of which has a proximal end (63) with a support section (35) of the last ring ( 28) and with their distal end (64) are each in contact with a support section (35) of the penultimate ring (29).

14. Stent according to claim 13, characterized in that the connection supports (71, 72) via their respective proximal end (73) and each distal end (74) with the support sections (35) of the last (28) and penultimate (29) ring are in such a way that the connection supports (71, 72) intersect at a point (77).

15. Stent according to one of claims 1 to 14, characterized in that the last ring (28) and the connecting support (31) are integrally formed with one another.

16. Stent according to one of claims 5 to 15, characterized in that the respective support section (35) of the last (28) or penultimate (29) ring and a section of the at least one connection support (31; 61, 62) in contact therewith ; 71, 72) are connected to each other by a press sleeve (45; 68).

17. Stent according to one of claims 5 to 16, characterized in that the pointed arches (33) of the last ring (28) facing the proximal end (11) of the stent (10) opposite the distal end (14) of the stent (10 ) pointing pointed arches (34) are bent outwards.

18. Stent according to one of claims 1 to 17, characterized in that the supports (24) and the at least one connecting support (31; 61, 62; 71, 72) consist of a wire-shaped, elastic material.

19. Stent according to one of claims 1 to 18, characterized in that distal to a distal pointed arch (41) the distal marker (46) is arranged on the jacket (26) of the connection support (31).

20. Stent according to one of claims 5 to 19, characterized in that a proximal marker (47) is arranged distally to a support section (35) of the last ring (28) on the jacket (26).

21. Stent according to claim 19 or 20, characterized in that the marker (46, 47) is an X-ray marker.

22. Stent according to one of claims 1 to 21, characterized in that the prosthesis material (25) consists of textile material or of film.

23. Stent according to one of claims 1 to 22, characterized in that the prosthesis material (25) on the supports (14) and the at least one connecting support (31; 61,62; 71, 72) is attached by sewing, gluing or melting ,